Evaluation of Electrocardiographic T-peak to T-end Interval in Subjects with Increased Epicardial Fat Tissue Thickness

The relationship between epicardial adipose tissue volume on coronary computed tomography angiography and idiopathic ventricular tachycardia: a propensity score matching case-control study in Chinese population

Background

Large epicardial adipose tissue (EAT) volume is associated with the incidence of premature ventricular beats. The relationship between EAT volume and idiopathic ventricular tachycardia (IVT) is not yet clear. We aimed to investigate the effect of EAT volume on the risk of IVT.

Methods

This is a retrospective consecutive case-control study from January 2020 to September 2022. IVT patients (n=81) and control patients (n=162) undergoing coronary computed tomography angiography (CCTA) were retrospectively recruited. The patients in the control group were all hospitalized patients for different reasons, such as chest tightness, shortness of breath, chest pain, and so on. Demographic parameters and clinical characteristics of each individual were collected from the patient's medical records. We selected evaluation criteria for the conduct of a 1:1 propensity score (PS)-adjusted analysis. Multivariable logistic analysis was used to investigate risk factors for IVT. Furthermore, the impact of EAT volume on cardiac repolarization indices was assessed in IVT patients.

Results

Patients with IVT had a larger EAT volume than control group patients in the unadjusted cohort. Variables with P<0.10 in the univariable analysis and important factors were included in the multivariable analysis model, including body mass index (BMI), left ventricular ejection fraction (LVEF), early peak/artial peak (E/A) ratios <1, EAT attenuation, and EAT volume (per increase 10 mL). The multivariable logistic analysis found that EAT volume [per increase 10 mL, odds ratio (OR): 1.29, 95% confidence interval (CI): 1.17-1.41, P<0.001] was an independent risk factor for IVT. EAT volume (per increase 10 mL, OR: 1.43, 95% CI: 1.25-1.64, P<0.001) independent effect was demonstrated in the PS adjusted cohort (n=57 in both groups). The area under the curve of EAT volume to predict the risk of IVT patients in the PS adjusted cohort was 0.859. The sensitivity and specificity were 86.0%, and 75.4%, respectively. Furthermore, A large EAT volume of IVT patients had a longer time in Tp-e, and Tp-e/QTc, compared with low EAT volume.

Conclusions

Patients with IVT had increased EAT volume compared to control subjects. Our study revealed that large EAT volume is associated with an extended repolarization process in IVT patients. These insights are essential for understanding the mechanisms linking EAT with IVT.

Tp-e/QTc ratio, SYNTAX, and GRACE score in patients who underwent coronary angiography owing to acute coronary syndrome

OBJECTIVE

Ventricular arrhythmias following acute coronary syndrome (ACS) range from benign to life-threatening fatal arrhythmias. Tpeak-end (Tp-e) interval has been shown to be an important parameter in the assessment of repolarization dispersion. We aimed to evaluate the relationship between SYNTAX and Global Registry of Acute Coronary Events (GRACE) risk score calculated on admission and Tp-e interval and Tp-e/QTc ratio.

METHODS

A total of 421 patients were included in the study. The patients were divided into 2 groups as low SYNTAX score (≤22) and moderate and high risk SYNTAX score (>22). According to the GRACE risk score, the patients were divided into 2 groups; high-risk patients ≥140 and <140 low-risk patients.

RESULTS

In the group with SYNTAX score >22, the Tp-e interval (p<0.001) and Tp-e/QTc ratio (p<0.001) was found to be significantly higher than in the group with a SYNTAX score ≤22. Tp-e interval (p<0.001) and Tp-e/QTc ratio (p=0.002) was higher in patients with GRACE risk score ≥140 compared with patients with a GRACE risk score <140. The correlation between Tp-e interval and Tp-e/QTc ratio and SYNTAX score (r=0.489; p<0.001) and GRACE risk score (r=0.274; p<0.001) were found to be significant. A significant and independent correlation was found between the SYNTAX score and Tp-e/QTc ratio (β=0.385; p<0.001).

CONCLUSION

Tp-e interval and Tp-e/QT ratio increased in patients with severe coronary artery disease assessed with SYNTAX score. Tp-e interval and Tp-e/QT ratio increased in patients with a high GRACE risk score.

Different body parts' fat mass and corrected QT interval on the electrocardiogram: The Fasa PERSIAN Cohort Study

Background

Previous studies suggested that obesity and fat mass are associated with QT interval prolongation, but the role of different body parts' fat mass is unclear. The associations between total and regional fat mass (FM) and corrected QT interval (QTc) were investigated for the first time in this study.

Methods

In this sub-analysis of Fasa PERSIAN cohort Study data, 3217 subjects aged 35–70 entered our study. Body fat mass was assessed by bioelectrical impedance analysis and QTc interval calculated by the QT interval measured by Cardiax^® software from ECGs and Bazett’s formula. Uni- and multi-variable linear and logistic regression was performed in IBM SPSS Statistics v23.

Results

In males, the fat mass to fat-free mass (FM/FFM) ratio in the trunk, arms, total body, and legs were significantly higher in the prolonged QTc group (QTc > 450 ms). Trunk (B = 0.148), total (B = 0.137), arms (B = 0.124), legs (B = 0.107) fat mass index (FMI) showed significant positive relationship with continuous QTc (P-value < 0.001). Also, just the fat-free mass index of legs had significant positive associations with QTc interval (P-value < 0.05). Surprisingly, in females, the mean of FM/FFM ratio in trunk and legs in the normal QTc group had higher values than the prolonged QTc group (QTc > 470 ms). Also, none of the body composition variables had a significant correlation with continuous QTc.

Conclusion

Our study suggested that FMI ratios in the trunk, total body, arms, and legs were positively associated with QTc interval in males, respectively, from a higher to a lower beta-coefficient. Such associations were not seen in females. Our study implies that body fat mass may be an independent risk factor for higher QTc interval and, consequently, more cardiovascular events that should be investigated.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12872-021-02095-2.

Cardiac Adiposity and Arrhythmias: The Role of Imaging

Increased cardiac fat depots are metabolically active tissues that have a pronounced pro-inflammatory nature. Increasing evidence supports a potential role of cardiac adiposity as a determinant of the substrate of atrial fibrillation and ventricular arrhythmias. The underlying mechanism appears to be multifactorial with local inflammation, fibrosis, adipocyte infiltration, electrical remodeling, autonomic nervous system modulation, oxidative stress and gene expression playing interrelating roles. Current imaging modalities, such as echocardiography, computed tomography and cardiac magnetic resonance, have provided valuable insight into the relationship between cardiac adiposity and arrhythmogenesis, in order to better understand the pathophysiology and improve risk prediction of the patients, over the presence of obesity and traditional risk factors. However, at present, given the insufficient data for the additive value of imaging biomarkers on commonly used risk algorithms, the use of different screening modalities currently is indicated for personalized risk stratification and prognostication in this setting.

Correlation Between T Peak to End Interval and Left Ventricular Time to Peak Longitudinal Strain in Ischemic Cardiomyopathy Patients

Background

Ischemic cardiomyopathy is the most frequent etiology of heart failure with reduced ejection fraction (HFrEF) and a result of ventricular structural, functional and electrical remodeling. T peak to end (Tpe) interval is an electrocardiographic parameter that represents repolarization heterogeneity and had prognostic value for ventricular arrhythmia. Patients with ischemic cardiomyopathy face a significant burden of arrhythmias. Mechanical dispersion is a functional remodeling parameter that can be measured by time to peak longitudinal strain using speckle tracking echocardiography. This study aimed to assess the relationship between Tpe interval with time to peak longitudinal strain in ischemic cardiomyopathy patients.

Methods

This study was conducted with an observational analytical cross-sectional design. Ischemic cardiomyopathy subjects were included at Dr. Hasan Sadikin General Hospital, Bandung, from August to October 2019. Tpe interval was measured manually with the tangential method. Time to peak longitudinal strain was measured using speckle tracking echocardiography. The correlation between Tpe interval and time to peak longitudinal strain was analyzed using Pearson correlation.

Results

A total of 30 subjects were included in this study. The average age was 58 ± 8 years old, and the average left ventricular ejection fraction was 27±5.5%. The average of Tpe interval was 83.4 ± 7.62 ms, and the average time to peak longitudinal strain was 93.13 ± 34.51 ms. The Pearson correlation test showed a significant weak positive correlation (r = 0.386, 95% confidence interval: 0.029 - 0.743, P = 0.018) between Tpe interval and time to peak longitudinal strain in ischemic cardiomyopathy patients.

Conlucions

There was a significant weak positive correlation between Tpe interval and time to peak longitudinal strain in ischemic cardiomyopathy patients.

Is there a relationship between epicardial fat tissue thickness and Tp-Te/QT ratio in healthy individuals?

Introduction

Epicardial fat is a tissue that releases many proinflammatory and atherogenic mediators, with endocrine and paracrine effects on the heart. In this study, the implication of the EFT thickness (EFTt) on transmural dispersion of repolarisation (TDR) was analysed utilizing the T-wave peak to end interval (Tp-Te), the Tp-Te dispersion (Tp-Te (d)), and the Tp-Te/QT ratio.

Material and methods

One thousand seven hundred and thirteen subjects were enrolled in the research. The subjects were chosen to be healthy individuals, without any cardiovascular/systemic disorders or risk factors for atherosclerosis. Transthoracic echocardiography (TTE) was applied to all subjects, and EFTt was measured in both diastole and systole. The ECG measurements were taken from standard 12-lead surface ECG.

Results

Correlation analysis revealed that the EFTt is highly associated with the Tp-Te interval, Tp-Te/QT ratio, Tp-Te (d), increasing age, body mass index (BMI), body surface area (BSA), left ventricular (LV) mass, LV mass index, plasma glucose during fasting, triglycerides, and low-density lipoprotein cholesterol.

Conclusions

The study results showed that increased EFTt was associated with increased TDR values of Tp-Te, Tp-Te (d), and Tp-Te/QT ratio, even in the absence of other factors that could increase TDR and EFTt. Therefore, it can be stated that increased EFTt may cause an increase the risk for ventricular arrhythmia.

Investigation of the effect of epicardial adipose tissue thickness on cardiac conduction system in children with type 1 diabetes mellitus

Objectives Investigation of the association between epicardial adipose tissue thickness (EATT) and P-wave dispersion (Pd), QT dispersion (QTd), corrected QT dispersion (QTcd) and Tp-e interval in children with Type 1 Diabetes Mellitus (T1DM) was aimed. Methods Forty-one children with T1DM and 41 age- and gender-matched healthy children were included in the study. Demographical characteristics of all cases were examined. In echocardiography; in addition to conventional echocardiographic measurements, end-systolic EATT was measured from right ventricular free wall. In electrocardiogram; Pd, QTd, QTcd and Tp-e interval durations, as well as Tp-e/QT and Tp-e/QTc ratios were calculated. Correlation values between EATT and electrocardiographic parameters were also noted. Results Mean age of the patient group was determined to be 12.43 ± 3.04 years and that of the control group was determined to be 12.08 ± 2.56 years. There was no significant difference between the groups in regard to age, gender, body weight, height and body mass index. In the patient group; EATT, Pd, QTd, QTcd and Tp-e interval were determined to be significantly higher compared to the control group. In the patient group, no significant correlation was determined between EATT and Pd, QTd, QTcd and Tp-e. However, when both patient and control groups were evaluated together, a statistically significant positive correlation was determined between EATT and Pd, QTd, QTcd and Tp-e. Conclusions In children with T1DM, an increase in epicardial adipose tissue thickness and in risk of cardiac arrhythmias has been demonstrated. To reveal the possible unfavorable effects of EATT on cardiac conduction system in T1DM patients needs further studies.

Evaluation of Tp-e interval, Tp-e/QT ratio, and Tp-e/QTc ratio in patients with Behçet's disease

Objective:

Behçet’s disease (BD), a multisystemic inflammatory disorder, has been associated with a number of cardiovascular dysfunctions, including ventricular arrhythmias and sudden cardiac death. The mechanism of increased ventricular arrhythmias in BD remains uncertain. The aim of the present study was to assess the ventricular repolarization by using the Tp–e interval, Tp–e/QT ratio, and Tp–e/QTc ratio as candidate markers of ventricular arrhythmias in patients with BD.

Methods:

A total of 42 patients (mean age: 42.71±10.99 years) with BD and 50 sex- and age-matched healthy volunteers (mean age: 39.24±11.32 years) as the control group were evaluated. The risk of ventricular arrhythmia was evaluated by calculating the electrocardiographic, the Tp–e interval, and the QT, QTc, Tp–e/QT, and Tp–e/QTc ratios.

Results:

QTmax (p=0.005), QTcmax (p=0.015), QTmin (p=0.011), and QTcmin (p=0.024) were statistically significantly higher in the BD group than in the control group. The Tp–e, cTp–e, Tp–e/QT, and Tp–e/QTc ratios were also significantly higher in patients with BD than in the control group (80.26±4.55 and 74.74±6.47, respectively, p<0.001; 88.23±6.36 and 82.68±7.81, respectively, p<0.001; 0.21±0.01 and 0.20±0.01, respectively, p=0.008; and 0.19±0.01 and 0.18±0.01, respectively, p=0.01). Positive correlations were found between Tp–e/QTc ratio and disease duration (r=0.382, p=0.013).

Conclusion:

Our study showed that the Tp–e interval, Tp–e/QT ratio, and Tp–e/QTc ratio, which are evaluated electrocardiographically in patients with BD, have been prolonged compared with normal healthy individuals. A positive correlation was determined between disease duration and Tp–e/QTc ratio. These results may be indicative of an early subclinical cardiac involvement in patients with BD, considering the duration of the disease. Therefore, these patients should be more closely screened for ventricular arrhythmias.

Is There any Relationship Between Myocardial Repolarization Parameters and the Frequency of Ventricular Premature Contractions?

BACKGROUND

Ventricular premature contractions (VPCs) may trigger lethal ventricular arrhythmias in patients with structural heart disease. However, this role of VPCs in healthy people remains controversial once that not enough clinical trials are available. Recently, some myocardial repolarization markers, such as Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios, have been reported to be useful for predicting lethal ventricular arrhythmias in various clinical disorders without structural heart disease.

OBJECTIVE

In this study, we aimed to investigate the relation between VPC frequent and myocardial repolarization markers in individuals without structural heart disease.

METHODS

This study included 100 patients who had complaints of dizziness and palpitations. Twelve-lead electrocardiography and 24-hour ambulatory Holter recordings were obtained from all patients. VPC burden was calculated as the total number of VPCs divided by the number of all QRS complexes in the total recording time. P-values < 0.05 were considered significant.

RESULTS

Tp-e interval and Tp-e/QTc ratio were significantly higher in patients with higher VPC burden than in patients with lower VPC burden, and a positive correlation was found between these markers and VPC burden. Tp-e (β = 1.318, p = 0.043) and Tp-e/QTc (β = -405.136, p = 0.024) in the lead V5 were identified as independent predictors of increased VPC burden.

CONCLUSIONS

Tp-e interval and Tp-e/QTc ratio increased in patients with high VPC number. Our study showed that VPCs may have a negative effect on myocardial repolarization. This interaction may lead to an increased risk of malignant arrhythmias.